Looked After Children:
Are we looking after them?
Sometimes despite everyone’s best efforts, a child is removed from their parents’ care and into that of the local authority. This may happen when a family are not able to meet their needs, or when leaving the child in their current situation puts them at significant risk. This naturally implies that the parents weren’t doing a good enough job and essentially that we as service providers can do better. Therefore it’s vitally important that we do; do better that is.
But are we? Statistics have shown that looked after children have a 5 fold increased risk of all childhood mental, emotional and behavioural problems. Much of this could be attributed to adverse early life experiences with over half of looked after children having been subject to abuse or neglect previously. These differences continue into late adolescence and adulthood with care leavers being 5-6 times more likely to self harm and looked after children having higher rates of both school exclusion and youth offending.
The differences don’t stop there. Children in care have higher levels of risk taking behaviours including drug and alcohol abuse and looked after teenage girls are 2.5 times more likely to get pregnant as well as being at increased risk of sexual exploitation. The educational attainment of looked after children is well behind their peers with only 12% achieving 5 A*-C at GCSE in 2014 compared to 55% of all children. Unemployment rates on leaving school are 3 times higher. The list goes on…
It is recognised that 2/3rd of looked after children also have additional physical health needs. These can include anything from enuresis and asthma to coordination difficulties. There is statutory guidance created by the Department of Health for the assessment of health in looked after children. In England, this includes an initial health assessment by a registered medical practioner within 28 days of going into care, followed by 6 monthly (under 5s) or annual (over 5’s) review assessments.
With regular health input, immunisations and scheduled health surveillance rates should surely be higher than that of the general population where a degree of parental choice often comes into play. However this does not seem to be the case. In 2014, 87.1% of looked after children were up to date with their immunisations. This compares to 89% of all children across the UK at age 5 in the same year. Both fall below the WHO target of 95% and although immunisation rates continue to improve, there is clearly still work to be done.
The annual health check provides opportunity for health intervention. In 2014, only 88.4% of looked after children had attended their statutory annual health check. It was recognised that older children aged 16-18 were less likely to attend. A Wales Based Charity ‘Voices From Care’ undertook consultations with ‘looked after’ young people and explored their views on health care provision. Amongst other things, young people asked for more flexibility and creativity in their health care services and for mechanisms to be in place for young people to express their views. They also identified the need for clarity on issues of confidentiality and privacy and continuity of health care where possible. As part of the government consultation “Promoting the Health and Wellbeing of Looked After Children’ in 2002; young people also identified a need for information on sexual health, contraception, fitness, hair and skin care, depression and practical topics such as how to use a GP practice.
The new Welsh policy for supporting and promoting the health needs of looked after children in Wales incorporates the role of nurse specialists in undertaking statutory medical assessments of young people who with medical support are able to adopt a more flexible young person orientated approach to health care provision in this group. I’ve heard on the grapevine that a mobile phone app is coming into development through a business accelerator scheme in South Wales, allowing young people to feed back on their experiences of care to social services. Maybe health needs to jump on this bandwagon…
A child in care has the right to the same opportunities as any other child. Due to pre-existing physical or mental health problems as well as exposure to early adverse life experiences, they may require additional support in order to achieve is. When a child becomes ‘looked after’, we as ‘corporate parents’ have a duty to do all we can to help them achieve their full potential, make every contact count and help to bridge the gap.